Read twice and referred to the Committee on Finance.
The bill (Access to Prescription Digital Therapeutics Act of 2025) defines “prescription digital therapeutics” (PDTs) in the Social Security Act and adds them as a covered service under Medicare Part B (effective Jan 1, 2026) and under Medicaid. It requires the HHS Secretary to establish a payment methodology within one year, create product-specific HCPCS codes (with temporary codes until permanent ones exist), and requires manufacturers to annually report private payor payment rates, volumes, and user counts starting Jan 1, 2026.
Support vs cost: left/centrist emphasize access; right emphasizes fiscal cost.
Relative to its intended legislative type, this bill is a substantive statutory amendment that establishes coverage authority for prescription digital therapeutics and supplies a moderate level of administrative structure (definitions, delegated payment rulemaking, coding deadlines, reporting obligations, and penalties).
The bill (Access to Prescription Digital Therapeutics Act of 2025) defines “prescription digital therapeutics” (PDTs) in the Social Security Act and adds them as a covered service under Medicare Part B (effective Jan 1, 2026) and under Medicaid.
It requires the HHS Secretary to establish a payment methodology within one year, create product-specific HCPCS codes (with temporary codes until permanent ones exist), and requires manufacturers to annually report private payor payment rates, volumes, and user counts starting Jan 1, 2026.
The bill includes civil monetary penalties for misreporting, treats reported information with confidentiality similar to certain drug data, and provides definitions and reporting rules for implementation.
Narrow, non‑ideological bill with implementation detail; likelihood limited by potential cost concerns and need for floor time or attachment to larger packages.
Relative to its intended legislative type, this bill is a substantive statutory amendment that establishes coverage authority for prescription digital therapeutics and supplies a moderate level of administrative structure (definitions, delegated payment rulemaking, coding deadlines, reporting obligations, and penalties). It is legally coherent in its integration with existing statutory provisions and assigns clear administrative responsibility and timelines, but it stops short of providing fiscal provisions, specific payment formulas, and program evaluation requirements that would be proportionate to a nationwide coverage expansion.
Support vs cost: left/centrist emphasize access; right emphasizes fiscal cost.
These are examples from the analysis, not a ranked list of the most-affected groups.
Support vs cost: left/centrist emphasize access; right emphasizes fiscal cost.
Generally supportive because the bill extends Medicare and Medicaid coverage to digital therapeutics and pushes manufacturer price transparency.
Concerned about evidence standards, patient out-of-pocket costs, and whether payment rules prioritize equitable access and health outcomes.
May want stronger safeguards for clinical effectiveness and affordability.
Cautiously favorable: pragmatic expansion of coverage with administrative steps (coding, reporting, payment methodology).
Wants clarity on budget impact, implementation details, and safeguards against overpayment.
Will weigh administrative feasibility and cost controls during rulemaking.
Skeptical: supports innovation and patient access in principle but worries this expands federal entitlement spending and creates new regulatory burdens.
Concerned about government-influenced pricing, manufacturer reporting requirements, and potential for higher taxpayer cost.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Narrow, non‑ideological bill with implementation detail; likelihood limited by potential cost concerns and need for floor time or attachment to larger packages.
The bill has not accumulated any surfaced votes yet.
Support vs cost: left/centrist emphasize access; right emphasizes fiscal cost.
Narrow, non‑ideological bill with implementation detail; likelihood limited by potential cost concerns and need for floor time or attachmen…
Relative to its intended legislative type, this bill is a substantive statutory amendment that establishes coverage authority for prescription digital therapeutics and supplies a moderate level of administrative structu…
Go beyond the headline summary with full stakeholder mapping, legislative design analysis, passage barriers, and lens-by-lens tradeoff breakdowns.